Nerve Transfer for Facial Paralysis Under Intravenous Sedation and Local Analgesia for the High Surgical Risk Elderly Patient.

Background: This case report describes an 86-year-old woman with complete peripheral right-sided facial paralysis resulting from resection of a cervical lipoma 14 months before surgery.

Case Description: Because of the high anesthetic risk, a masseter to facial nerve transfer was performed under combined light sedation and local anesthetic. Good functional and aesthetic outcomes were noted without complications.

Microvascular Staged Phalloplasty Preserving Original Glans in a Severe Hypospadias: A Case Report.

Penile reconstruction is usually performed in patients with gender dysphoria; with penile loss because of trauma, infection, and tumors; and with congenital deformities like severe hypospadias, in which standard techniques do not achieve a good result. Hypospadias are one of the most common inherent genital anomalies in boys. Many surgical procedures have been published for total phallic reconstruction aiming at a functionally and aesthetically pleasing.

Hand Amputations at the Radiocarpal Level With Proximal Neuromuscular Avulsion.

Purpose: To report a series of 6 radiocarpal avulsion amputations in 5 patients.

Method: We replanted 6 radiocarpal amputations in 5 patients with proximal musculotendinous and nerve avulsion between 2005 and 2013 and reviewed them retrospectively. All 5 patients were men, age range from 21 to 32 years.

Reconstruction of the lateral malleolus in a type-Ib fibular hemimelia with a microvascular proximal fibular flap: a case report.

Fibular hemimelia, or fibular hypoplasia-aplasia, is the most frequent congenital long-bone deficiency. There is still some debate on reconstruction versus amputation for the severe type Ib and type II cases. Limb-length discrepancy can be corrected with Ilizarov methods, but ankle stability remains a problem.

Primary Central Nervous System Posttransplant Lymphoproliferative Disease in a Bilateral Transfemoral Lower Extremity Transplantation Recipient.

Posttransplant lymphoproliferative disorder (PTLD) is a heterogeneous group of clinical and pathological entities characterized by malignant lymphoid cell proliferation occurring after solid organ transplantation, with frequent extranodal involvement. Central nervous system (CNS) involvement occurs in 7-15% of the cases and it is a significant negative prognostic factor. A case of primary CNS (PCNS) PTLD in the first bilateral lower limb transplant recipient is presented.

Late nail lesions rejection in a stable bilateral forearm allograft at 60 months posttransplantation.

We present a case of late nail lesions rejection in a stable and compliant bilateral forearm allograft at 60 months posttransplantation, confirming that rejection features in vascularized composite tissue allotransplantation are more heterogeneous with multiple clinical implications, despite apparently appropriate immunosuppressive treatment. Our observations may help to better characterize and to fully understand the onset and dynamics of skin rejection after human hand allotransplantation; nevertheless, further investigations are required, and careful monitoring of the grafts by direct inspection is advisable in all patients to start rapidly appropriate and effective treatment.

Salvage of infected intramedullary knee arthrodesis with vascularized free fibula and staged fixation.

Intramedullary knee arthrodesis is indicated when an infected total knee arthroplasty revision is failed. There is a high risk of infection after this procedure and the only option of treatment considered in these cases is AK amputation. We present an alternative to AK amputation in intramedullary arthrodesis infected cases that has been successful in all patients we have treated.

Lymphedema after upper limb transplantation: scintigraphic study in 3 patients.

Lymphatic vasculature is known to spontaneously reconnect after hand replantation. Nonetheless, lymphatic outflow has not been specifically studied in hand transplantation.Lymphedema was studied clinically and scintigraphically in 3 bilateral upper limb transplants performed in Valencia, Spain, since 2006.

Urethra reconstruction with a prelaminated pedicled anterolateral thigh flap: a case report.

We present a case report of urethral reconstruction with a pedicled anterolateral thigh flap prelaminated with bladder mucosa in sex reassignment. The successful outcome may make this technique worthy to be considered in the secondary reconstruction of urethra in difficult cases. To the best of the authors' knowledge, no similar case has been previously described.

Bilateral transfemoral lower extremity transplantation: result at 1 year.

Upper limb transplantation has become a treatment option for upper limb amputees with good midterm results. Lower extremity transplantation has never been considered for fear of poor results. The authors present a bilateral transfemoral transplantation of lower extremities performed to a 22-year patient at 12 months of follow-up.

The case for lower extremity allotransplantation.

Background: Despite generally excellent success with vascularized composite allotransplantation at many body sites over the past two decades, vascularized composite allotransplantation as a treatment modality for lower extremity amputees has not yet been fully embraced.

Methods: The authors summarize the anticipated benefits of lower limb allotransplantation, and reference the likely controversies relevant to this restorative therapeutic modality.

Result: Based on evidence culled from both upper extremity and lower extremity transplant experience to date, the authors posit that allotransplantation for lower limb amputees may be a reasonable pursuit.

Secondary surgery for functional improvement after hand transplantation.

Unilateral and bilateral hand transplantations have been performed worldwide with good midterm functional results. The role of secondary surgery to improve function in the patients with hand transplant has not been uniformly agreed upon. A series of 10 secondary procedures were performed in 5 surgeries on 3 patients with bilateral upper extremity transplantation.

Surgical aspects of a lower face, mandible, and tongue allotransplantation.

Face transplantation is a novel treatment for the reconstruction of massive facial defects. To date 13 cases have been performed. The technical aspects of a composite lower face transplantation including the tongue, floor of the mouth, and most of the mandible are detailed.

Secondary ectopic transfer for replantation salvage after severe wound infection.

Background: Ectopic transfer has been described as a salvage procedure in failing replants. The experience in three cases of infected failing replantations treated with secondary temporary ectopic transfer of the replanted part is presented.

Methods: Three patients with replanted traumatic amputations (one transhumeral, one transmetacarpal, and one transtibial) that developed severe wound infections and thrombosis of the anastomoses were treated with urgent ectopic transfer of the replanted part.

Bilateral trans-humeral arm transplantation: result at 2 years.

Unilateral and bilateral hand transplantations have been performed worldwide with good mid-term functional results. An above-elbow bilateral transplantation was performed in a 29-year-old male patient from a fully HLA-mismatched donor. Alemtuzumab induction and steroid-free maintenance immunosuppression with tacrolimus and mycophenolate was used.

Reconstruction of massive bone losses of the elbow with vascularized bone transfers.

Background: Massive bone loss of the elbow in young patients is a complex injury. A series of five cases of massive loss of the elbow joint reconstructed with single or double vascularized bone transfers is reported.

Methods: Five patients with nonacute massive bone loss of the distal humerus (two cases) or distal humerus and proximal ulna (three cases) were reconstructed with a single (two cases) or double (three cases) microvascular vascularized bone transfer from the iliac crest, the fibula, or the scapula.

Reconstruction of the condyles of the proximal phalanx with osteochondral grafts from the ulnar base of the little finger metacarpal.

Purpose: Traumatic defects of the condyles of the proximal phalanx (P1) are challenging injuries. Use of osteochondral grafts from the hamate had been described for defects of the base of the middle phalanx. Extending this concept, the purposes of this study were to see whether an osteochondral graft from the base of the little finger metacarpal was anatomically feasible to reconstruct a condyle of P1, and to determine whether the reconstructions performed were clinically successful.

Elective cross-over transfer of the foot: case report.

The case of a patient with sequels of a right Syme amputation and a left replanted upper tibial amputation was treated with elective cross-transfer of the left foot and ankle to the right distal tibial stump, and the left below-knee (BK) stump was resurfaced with a latissimus dorsi free flap. The patient regained independent walking capacity with a left BK prosthesis at 8 months postoperatively.

Reconstruction of major traumatic segmental bone defects of the tibia with vascularized bone transfers.

Background: Segmental bone defects of the tibia after high-energy trauma are limb-threatening conditions. Multiple treatment options have been proposed, including nonvascularized bone grafts, vascularized bone transfers, and callus distraction. A series of 41 patients with major segmental defects of the tibia treated with vascularized bone reconstruction is presented.

Infrapopliteal lower extremity replantation.

Background: Replantation surgery in lower extremity amputations continues to be controversial. Overall results have been considered poor and the procedure is usually discouraged. It is the opinion of the authors that infrapopliteal replantation may be indicated.

Bilateral hand transplantation: result at 20 months.

On November 2006, a bilateral hand allotransplantation was performed for a 47-year-old female who had suffered radiocarpal amputations 28 years before. Technical aspects of the operation are detailed. Alemtuzumab induction, and triple therapy of tacrolimus, mycophenolate mofetil and prednisone were used to control rejection.